Photo Of The Day

by Lux on April 29, 2016 at 12:00pm

First claim: In an interview, Charles Cullen at first says he thought he was helping people by ending their suffering.

The Tainted Kidney

Charles Edmund Cullen (born February 22, 1960) is a former nurse who is the most prolific serial killer in New Jersey history and is suspected to be the most prolific serial killer in American history. He confessed to authorities that he killed up to 40 patients during the course of his 16-year nursing career. But in subsequent interviews with police, psychiatric professionals, and journalists Charles Graeber and Steve Kroft, it became clear that he had killed many more, whom he could not specifically remember by name, though he could often remember details of their case. Experts have estimated that Charles Cullen may ultimately be responsible for over 300 deaths, which would make him the most prolific serial killer in American history

Cullen, is serving eighteen consecutive life sentences in a New Jersey penitentiary. Behind bars, he can no longer take life, yet he’s found a way to give it—in the form of an organ transplant. But no one wants to give him the chance to play God again.

The Angel of Death looks sleepy. His face shows nothing. His eyes are closed. Charles Cullen sits motionless in the wooden defendant’s chair of the Somerset County Courthouse as, hour after hour, his victims’ families take the stand. They read poems and show photographs, they weep and yell. If Cullen hears them, he doesn’t say; he never does. During his years in custody, Cullen has never apologized or made excuses. He has never issued a statement, offered a public word, never faced the families of his victims. In fact, the only reason he’s in court today is because he wants to give away one of his kidneys.

To that end, he has cut a deal with prosecutors, agreeing to appear at his sentencing on the condition that he be allowed to donate an organ to the dying relative of a former girlfriend. To many of the families of his victims, this deal is a personal insult—the man in shackles still calling the shots, the serial-killer nurse wanting to control the fate of yet another human life. But for the families of his New Jersey victims, this is the first and last chance to confront Charles Cullen. So they are here, and they are angry.

“My only consolation is that you will die a thousand deaths in the arms of Satan,” yells the daughter of a man Cullen spiked with insulin. “I hope, with all my heart, that you are someone’s [expletive] in prison.”

“You are a pathetic little man,” says the woman whose mother-in-law Cullen killed with digoxin. “In prison, perhaps someone will choose to play God with Mr. Cullen, as he has played God with so many others.”

“Charles!” cries a round woman in a lime-green pantsuit. Her body shakes in rage and grief; her hands grip a photograph of her 38-year-old son, a picture taken before Charles Cullen stopped his heart. She is screaming. “Charles, why don’t you look up at me, huh? What are you, asleep?”

In fact, Charles Cullen is very much awake. His shackled hands, which look from a distance as pale and still as sleeping doves, twitch slightly in his lap, counting off silent prayers, Jesus Christ, son of God, have mercy on me, as if on invisible rosary beads; the expressionless shield of his cheek still tics when “burn in hell” hits his ear. His eyes open slightly, like a child pretending to be asleep, Cullen can see only a twilight view of the table, the cups, the stenographer with her leg crossed over the other, light shining hard off her shoes.

“The state asks for thirteen life sentences,” says the assistant prosecutor, and there is a wrinkle on Charles Cullen’s brow, a flexed cheek enunciating “thir-teen,” then the blankness returns, and there is again just what Cullen can see in front of him: the wooden table, the stack of pastel Dixie cups, a black plastic pitcher, and beyond, lit by her own little spotlight of halogen, the stenographer, her hands bouncing like puppets. And then Judge Armstrong is asking if the defendant has anything to say on his own behalf, anything at all about these horrendous crimes against man and nature, and the stenographer’s hands stop and wait. Cullen has no comment. With a rap of the gavel and screeching of chairs, it is over. Charles Cullen is hustled into a back room with men in riot gear holding automatic weapons, then he is gone, leaving behind a courtroom full of questions.

As far as the law is concerned, there isn’t much left for Cullen to say. On December 12, 2003, Cullen was brought in for one first-degree murder and one attempted murder as a critical-care nurse at Somerset Medical Center in Somerville. The next day, he shocked Somerville detectives by confessing to many more murders. Cullen told detectives that he killed the sick in order to end their suffering, but at some point, as Cullen spiked bags of IV saline in supply closets and killed patients who were not terminal, his compassion became compulsion, and when his personal life became stressful, killing became his outlet.

Exactly how many patients he murdered, we will never know: His memory of his crimes, he says, “is foggy,” and he drank heavily to make it foggier. He worked graveyard shifts in intensive-care units, largely unsupervised in a dark punctuated only by the beeps and breaths of medical machines. Many of the medical charts are missing or incomplete; the dead are now dust. His method was to overdose with drugs so common that sorting Cullen’s private death toll from the general cadence of hospital mortality is nearly impossible.

Cullen guessed that he had killed 40 people. So far, investigators have positively identified 29 victims (confirmation of a 30th victim is currently pending). It’s unlikely that the tally will ever be complete; even Cullen’s lawyer, Johnnie Mask, told prosecutors they weren’t finished. Some investigators with an intimate knowledge of the case are convinced that the real number is over 300. By that reckoning, Charles Cullen would be the biggest serial killer in American history.

After Cullen was arrested, New Jersey prosecutors agreed to take the death penalty off the table in exchange for his full cooperation. Cullen would help identify his dead, then spend the rest of his life in prison. He was 44 years old.

Months turned to years at the Somerville jail, and Charles Cullen’s life assumed a regularity he had rarely known as a free man. He had his cell, his spy novels, time to exercise or shower. Uniformed men turned the light off and on, governing day from night. Once a week, he met with his Catholic deacon or the head chaplain, the Reverend Kathleen Roney, and every so often, he never knew when, the guards would escort him across the lawn to the prosecutor’s office, to pull through the case files.

Cullen studied the scrawled medical charts, the arrhythmic EKGs, the final flatlines, and the blood work afterward—the primary investigator in the search for his own victims. There were new charts nearly every week, boxes of them, covering sixteen years of death at nine hospitals. Winter became spring and winter again, but Cullen just kept squirreling through the files with a cup of black coffee, getting thinner, getting it done; eventually, when the investigations were closed and the shouting echoed out, he could take his life sentences into a cell and disappear completely.

Then in August 2005, an envelope arrived at the Somerville jail. By now, Cullen was inured to the interview requests and the hate mail, even the odd “fan letter.” He never answered any of them, of course, but this was something new—a story about a man named Ernie Peckham, clipped with kitchen scissors from a local newspaper on Long Island. In the margin was a note in a girlish cursive: “Can you help?”

Cullen knew about Ernie—a guy about ten years younger than Cullen, with four kids and a wife at home and a job shaping metal in Farmingdale. Ernie was the brother of Cullen’s estranged ex-girlfriend, who was the mother of Cullen’s youngest child—a little girl he had never seen. Maybe he and Ernie had said hi once at a wedding years ago; Cullen couldn’t recall, but they weren’t friends, they weren’t even acquaintances, they certainly weren’t close enough to share organs. But an organ is what Ernie Peckham needed.

Doctors don’t know exactly how or when, but at some point in 2002, Ernie contracted strep. Probably it was just a little scratch that got infected, the sort of thing that either swells up and goes away or takes you out for a week with a sore throat that can be treated with a dose of antibiotics. But Ernie didn’t notice the infection, and it spread, overloading the microscopic filters in both of his kidneys.

Normally, these filters would have been removing toxins from Ernie’s blood; now they were like a sink clogged with hair. Ernie’s body began to bloat with its own poisons, swelling his hands and face and turning his urine the color of cocoa. By the time he saw a doctor, his kidneys were dead. Untreated, he’d be next. Doctors could filter Ernie’s blood three times a week with dialysis, but this was a stopgap measure; what Ernie really needed was a new kidney. Unfortunately, so did 60,000 other Americans. As Ernie’s health deteriorated, the seven-year waiting list for a cadaver donor would become a death sentence.

Charles Cullen, a former nurse who claims to have killed patients at hospitals in New Jersey and Pennsylvania, hacked a hospital drug dispensing system to commit his crimes. Cullen, shown here in court in 2004, pleaded guilty to killing 24 patients and trying to kill five others. Photo: Mike Derer / Associated Press.

His only other option was to receive a kidney from a living donor (although most everyone has two kidneys, you only need one). The best way to match kidney with recipient is through a blood relative—but nobody in Ernie’s family, nor any of his friends, was medically eligible to donate. His only chance was to find the perfect stranger. But how many people are willing to donate an organ to someone they don’t know? Worse, the odds that Peckham would be a perfect six-for-six tissue-typed match with any one random donor were incalculably small. Ernie Peckham actually had a better chance of being struck by lightning.

Ernie’s mother, Pat Peckham, contacted the local paper to run a public-interest item with Ernie’s blood type above the hospital’s donation-hotline number. No miracle donor called.

Pat was running out of options for saving her son. And what would it take except a stamp? So, without telling Ernie, she clipped the article out of the paper, stuck it in an envelope to the Somerville prison, and waited for her miracle.

The thing about miracles, you can’t really predict what form they might take. They might come from anyone, even the serial killer who had knocked up her daughter.

The Reverend Kathleen Roney wears rock-collection-size birthstone rings on her fingers and Celtic charms around her clerical collar and paint-on eyebrows that flick like conductor’s batons as she talks. Roney started ministering to Cullen soon after his arrest. She figured the meditation techniques of the Desert Fathers would be appropriate for a man spending life in prison: The “Jesus Prayer” Cullen recited through his Somerset sentencing came from one of Roney’s tutorials.

Over the course of nearly three years, Roney had gotten to know Cullen, but that didn’t mean she understood him. She didn’t, for instance, understand why Cullen had killed so many people—but her job wasn’t to comprehend the serial killer, only to minister to the man. And she couldn’t quite understand why, suddenly, he was so desperate for her help to donate a kidney; 22 years as a jail chaplain, and nobody had ever asked for anything like it. “So that night I went to the jail and questioned him,” she says. “To make sure I wasn’t being used.”

Roney isn’t a big woman, but she’s blessed with the bullhorn voice and big-girl swagger that jail work requires, and she can turn it on when she has to. She called for Cullen, who was reading in his cell, and she asked him: “Why this? Why now? Do you want it for fame, or to rehabilitate your public image? Do you think you’re making some deal with God, to save a life to wipe out the lives you took?” Or did he hope that he might die on the operating table in some sort of passive suicide attempt?

“The questions seemed to really hurt his feelings,” Reverend Roney says. “But that was okay. I needed to know his heart.”

Roney said she’d think about it, and drove through the dark to pray in front of her icons. Charles had told her he was serious, that he wanted to see if he was a match. He wanted to donate because he was asked, and it was good. But should she believe him? The more she examined the question, the simpler it became. She was a minister, a Christian, and there was a life at stake, a guy on Long Island named Ernie. Cullen could never orchestrate a donation alone from behind bars. He needed her help—they needed her help. How could a compatibility test be a moral dilemma?

The hospital sent color-coded tubes for Cullen to bleed into. She would be the blood mule; Stony Brook hospital on Long Island would test his antigens against Ernie’s. From what she read on the Internet, a match was an incredible long shot. But at least everybody could say they tried.

When she asked her friends to pray with her that weekend, she didn’t tell them what they were praying for or for whom. “We needed to keep it secret,” she says. “And besides, could you ask every person to pray for a serial killer?”

Every equinox, Reverend Roney and like-minded Celtic Christians spend a week at a Druid spiritual retreat in Pennsylvania. It’s a profound time for her, a time of dancing around bonfires and meditating before icons and spirit-voyaging through unbounded acres of blond American farmland. Every morning, she’d walk the hard earth between the corn stubble, reciting her prayers, feeling the ancient wisdom, looking for a sign. It was then that she felt the vibration.

That was her cell phone—they encourage silence at these things, so she had it on vibrate—and right away, she knew what had happened. And her prayer group knew, too. In fact, the whole spiritual retreat knew what had happened; they just felt it and started to cry, because they knew. And she thought, This is it, it’s meant to be.

She’s crying now, retelling the story over an iced tea, ruining her mascara, remembering how Cullen was a perfect six-for-six antigen match, a match like winning the Publisher’s Clearing House sweepstakes, and she wipes the tears away with a Starbucks napkin. “Honestly, we thought it was a miracle,” she says. There would be more tests, X-rays, cat scans, tests with machines you couldn’t send to the jail by mail. But these were trivial compared with this spotlight in the darkness, a sign of God’s larger plan.

In that halcyon moment, Reverend Roney couldn’t imagine the lost friendships of her fellow Christians; she thought it was as easy as helping Charles donate to save a dying man. It was September; if she acted fast, the kidney would be like an early Christmas present.

When Roney called Pat Peckham, Pat didn’t believe her. “Are you sure?” she asked. It was so improbable, it was so—then Pat started to scream. “Then I’m screaming, then she’s crying, then I’m crying,” Roney remembers.

Roney would have loved to have seen the look on Ernie Peckham’s face when Pat told him the news. But Pat wasn’t going to tell her son, not for a while, and she certainly wouldn’t tell him the name of the donor. As sick as Ernie was, Pat was sure Ernie wouldn’t accept a kidney if he learned it came from Charles Cullen.

The Somerset County jail is a redbrick building conveniently catty-corner to the Somerville courthouse. On the other side of the metal detector is a wall of two-way mirrored plate glass backlit by video surveillance. Beyond that is the nine-by-five-foot cell where Charles Cullen had spent the past two and a half years of his life.

The sergeant buzzes me through a series of doors into a hallway partitioned into stainless-steel booths. Guards escort Charles Cullen onto the opposite stool. We nod mutely to each other across the bulletproof divide, and take a phone.

“Hello? Hello?”

“Hello?” I say. “Can you hear me?”

“Yeah,” he says. “I can make you out.” His voice is flat and quiet. I press the plastic phone hard to my ear, and Cullen notices. “Did you get in all right?” he says, louder.

“It took two hours,” I say.

Cullen glances up, reading my expression before retreating to the corners of the glass. “That happens,” he says. He nods once. “It changes in here, week to week.”

In pictures taken soon after his arrest, Cullen looks a little like Kevin Costner or a hollowed-out George Clooney—perhaps a bit colder, yet still a handsome guy with a bad haircut. But now, in the mercury vapor lights of the Somerset jail visiting room, Cullen looks chapped and anemic. Never an eater, he has become skeletal in jail. His face seems to hang from his cheekbones like a wet sail. A crucifix dangles from a chain over his collarbone, mixing with the sprigs of graying chest hairs where his shaven neck meets his prison togs—essentially mustard-yellow versions of hospital scrubs, insulated with a layer of white flannel underwear. His eyes dart and flash like a man holding his breath, waiting to talk.

He tells me about the afternoon when Reverend Roney came to his cell, excited to tell him that he was an “excellent match” for Ernie Peckham. Cullen was happy, but his years in jail had taught him that nothing would ever be simple. “The match means the donation will happen—it’s meant to happen,” Roney told him. “Yeah,” Cullen responded. “Well, I hope the courts think that.”

Cullen knew that if word ever got out that he was trying to donate a kidney, the whole thing would probably be over right there. He needed to keep it secret; nobody could know. “I mean, it’s not like I’d want the publicity,” Cullen says. “But mostly I thought that if it got out, it would be bad for the donation. The way people think of me, they would think I was trying to do something. But someone leaked it—I think it was the D.A., but I don’t really know. And now … ” he rolls his eyes. The press was having a field day.

“I know people see me as trying to control things; they think I’m trying to get something out of it. But the idea that I was trading my appearance at sentencing for the donation are out-and-out lies,” he says. “I was told by my lawyer, Mr. Mask, that I didn’t have to appear.” He shakes his head, and almost smiles. “I mean, you know, who would want to go? All those people that you—but the donation was important. The detectives suggested that I offer to go, to speed the donation along. They said I needed to give them something. But that’s not me holding a gun to the prosecution. It’s the other way around!

“I grant that I certainly have done some very bad things—I’ve taken lives,” he says quickly. “But does that prevent me from doing something positive?” Cullen folds a pale arm tightly across his chest and studies the counter. “That’s the funny thing,” he says. “People think you’re crazy for doing something for someone else if you don’t know them personally.”

The New Jersey office of the Public Defender is two stories of red brick with handicapped spaces and shrub landscaping and 300-pound women in nightgown-size Tweety Bird T-shirts smoking menthols by the double glass doors. In the offices upstairs, there are families in sweatpants waiting under fluorescent lights and a hole in the Plexiglas where you can announce yourself by sticking your mouth in and yelling politely.

Johnnie Mask’s office is in the back. The deputy public defender looks something like an Old Testament James Earl Jones—a big man with broad leonine features and a gray Ishmael beard gone grayer over three years defending the biggest serial killer in New Jersey history.

It was a nice idea, giving a kidney, but Mask wasn’t in it for the karma. “My motives were purely selfish,” Mask says. “Charlie was absolutely intent on making this donation happen. I was worried that if he didn’t get his way, he’d mess up my case, and all my hard work would go down the drain. More work for me, more expenses for the state—there was no way I was going to let that happen.”

But right from the beginning, Mask saw signs that this thing might not go through. “Judge Armstrong signed the order for the blood test, but I don’t think anybody really expected he’d actually be a match for Ernie,” Mask says. “When he was, and it got into the papers, suddenly there are all these problems. The judge and the prosecutor and the victims’ families got up in arms about Cullen going into a hospital again—they figured he’d kill somebody, or probably himself. Then everyone would be cheated out of their ability to yell and scream at him.”

Mask was told that the donation was possible only after Cullen was sentenced. That was supposed to happen by December 2005, but a month later, two counties still hadn’t even finished their investigations. “That’s why on January 10, Charlie stopped cooperating with the prosecution, saying ‘Sentence me now.’ ” By breaking his plea agreement, Cullen seemed to be risking the death penalty for the donation, but really it was a tactical move by Mask. “It forced their hand. We realized that by the time they finished, Ernie might be dead.”

“The Angel Of Death” – Charles Edmund Cullen.

They were months behind schedule, but, in theory, Cullen was about to be transported to Stony Brook Medical Center and donate his kidney side by side with Peckham. “But when [Attorney General Peter] Harvey wanted Cullen to cooperate, he was saying, you know, ‘We’ll work out the details later, but it will happen,’ ” Mask recalls. “We were counting on those promises, but he just wanted to wrap up the case before he took on his new job in the private sector.”

A few weeks later, weeks when Ernie Peckham’s condition continued to deteriorate, Mask walked by the desk of Vaughn McCoy, who was then the director of New Jersey’s Division of Criminal Justice. “I asked him what the status was. He pulled up some e-mails and said, ‘Well, apparently Stony Brook doesn’t want Mr. Cullen in their hospital.’ I tried to lean over and read it off his monitor, but he sort of blocked me.” Mask smiles joylessly. “Said it was confidential.”

By now it was February. “So what can you do? Then the old A.G. leaves, and the new attorney general’s office tells us Cullen can’t travel to New York anyway—it’s not legally feasible!” Mask shakes his head at what’s become an old joke.

“I don’t know what’s true now. We thought it would happen in January. Stony Brook keeps giving us new dates—they’re saying April now; before, it was March. And Charlie’s getting more aggravated every day. I think [allowing the] donation was always just a big dangling carrot to get Charlie to jump.” It was the only reason Cullen agreed to appear at the sentencing in New Jersey. Mask was still working toward the donation, but he’d bet Roney a dinner it would never happen.

It was a good bet, especially considering what was about to happen at Cullen’s next court appearance.

The New Jersey courts were done with Charles Cullen, but Pennsylvania still had unfinished business, and so as Ernie Peckham’s condition worsened even more, Cullen was transported west to stand trial for the six murders and three attempted murders he committed in Lehigh County, while working at the hospitals surrounding Allentown.

Allentown is a poor steel town living in the ruins of a rich one, and the downtown is a grand, ceremonial public space of imported stone and soaring columns and busted crazies rooting for cans, joined now by a small parade of families in dark, formal clothes with little blue stickers from OfficeMax gummed to their lapels to show they’re families of the victims of the Angel of Death.

In a legal sense, sentencing Cullen for his Pennsylvania crimes is perfunctory—he won’t be finished serving his New Jersey sentence until the year 2347—but for the families of patients Cullen killed here, today’s sentencing is their only chance to confront the Angel of Death with their memories and their anger. It’s also an opportunity for Cullen, a final shot at showing the world that he is, as he claims, a killer with compassion. A public demonstration of that compassion would go a long way toward saving Ernie Peckham’s life. In Pennsylvania, Cullen could do what he hadn’t done in New Jersey.

Just like the victims’ families at Cullen’s New Jersey trial, the families who fill the Allentown jury box have brought poems and speeches and photographs of the dead and are prepared to exercise their right to confront the killer. But this time, Cullen rises to speak—reciting, from memory, statements Cullen believes have been hostile to him that the judge has made to the press.

The high marble walls make this court a beautiful room but a terrible courtroom, amplifying and distorting all sound. Cullen fills this room. The families wait as Cullen gets to speed-shouting his statement ten times, 30, 40. He’s not going to stop, and now the court officers are on him.

They pull a spit mask over his head—a mesh veil that keeps a prisoner from hawking loogies on his captors—but the noise continues. They wrap the spit mask with a towel and screw it behind his head and now Cullen sounds like a man screaming into a pillow. The families of the victims try to read. “You are a total waste of a human body.” “You are the worst kind of monster, a son of the devil.” But soon the sergeant’s hands begin to cramp, and chorus by chorus, Cullen’s voice gets clearer. Judge Platt nods, and the sergeant produces a roll of duct tape the size of a dinner plate, and tapes a big cartoonish X over Cullen’s lips, which does nothing. And so the victims read their personal statements, and Cullen screams his, like a nightmarish version of “Row, Row, Row Your Boat.”

“If my grandmother was alive right now, she’s say to you, ‘I hope you rot in hell, you sick son of a [expletive].’”

“Your honor, you must step down. Your honor, you must step down.”

“Six more life sentences, served concurrently with those already handed down.”

“Must step down. Your honor, you must…”

And with a final “Such that you will remain in prison for the rest of your natural life,” the court officers frog-march Cullen—bound, gagged, duct-taped—into a waiting elevator. He is still chanting when the doors close. The silence that follows is terrible, too.

Afterward, the families huddle in the hallway, shaken and unsatisfied. “I think he intentionally meant disrespect to everyone in that courtroom,” says Julie Sanders, a friend of one of Cullen’s victims. Sanders stabs her finger toward the hole in the air where Cullen had been. “He says he is a compassionate man, that he wants to donate a kidney to save someone’s life. I needed to say something to him: Where’s the compassion now? Does he know what he’s done to our lives?”

Now what Mask and Roney had wasn’t a legal problem—they had a court order authorizing the donation from Judge Armstrong—it was bigger. “Basically, there’s not a lot of goodwill toward Charlie Cullen among the citizens of New Jersey,” Mask says. “Nobody wants to seem to be kowtowing to a serial killer’s requests. Some of the families see his donation request as a slap in the face. It’s like he’s asking them for a favour.”

After the scene at Allentown, Cullen’s kidney was simply too hot to handle. Roney would call the D.A.’s office, which told her to call the New Jersey Department of Corrections, who’d tell her to call the hospital. Months passed with no answers, no schedule, no deadline. If the donation was going to proceed, there were state and private institutions to coordinate, insurances to interface. The Corrections Department would need to guard Cullen in the hospital, against escape and vigilantes and, because he had already attempted suicide multiple times, Cullen himself. The only ones with real deadlines were Cullen and Ernie. Cullen’s donor test was valid for only a year; Ernie might not even survive that long.

And then there was the kidney, which would need to travel 125 miles from Cullen’s hospital in New Jersey to Peckham’s hospital on Long Island fast enough to keep it viable. Depending on traffic, that could be a bitch of a drive. A construction snarl or a fender bender or even a Hamptons rush hour could imperil Ernie’s life, but who was going to pay for a helicopter?

Ironing out the details would require a lot of hard, unpaid work by a great number of people, but at this point, Cullen was the last guy anyone wanted to do a favor for. That’s how they saw it, a favor to Cullen, not a way to save another man’s life. “It’s his choice, he’s a grown man, but realistically, the stuff he does in front of the victims’ families isn’t winning him any points either,” Mask says.

“And Charlie doesn’t really feel bad about any of this. He’s concerned how it affects his kids, but he doesn’t feel bad. And Charlie’s not the kind of guy to fake it,” says Mask. “It makes some people feel like he’s getting away with something.” Prison was supposed to take away his options. And yet there he was, still making demands.

After Allentown, his final sentencing, Cullen was shackled in the back of a windowless van. He was met at the Trenton prison by guards in riot gear. They strip-searched him, gave him prison clothes, and led him to the psych ward, where they took the clothes away and strip-searched him for a second time. He was handed a disposable gown like medical patients wear, but it was made from the stuff they wrap around new TV sets, and he was put into a padded room for a 72-hour observation period. The gown shredded after the first day. He tried not to listen to the “time for your insulin” comments from the guards, focusing instead on Psalm 25: “My enemies are many, they hate me. Deliver me, let me not be ashamed.” Then he was given clothes again and moved into DD Block, where he was to serve his now eighteen life sentences, and where I visit him again.

From the Trenton River Line train, the prison appears as a block of brick and razor wire across the highway from a McDonald’s. Another minute’s walk past the front gate gets you to a security check-in with a metal detector and a uniformed guard. After a pat-down, you’re buzzed through three bolted steel doors and into a guarded hallway partitioned into steel booths. I find Cullen waiting in the third one, waving a little hello. We nod mutely across the bulletproof divide, and plug in our phones. There is static, then breath.

Cullen and I had been communicating through letters for nearly a year, and I had learned a lot about the man—his accidental entry into nursing school and his first job scrubbing dead skin from burn victims, the depressions and suicide attempts and marital problems, his drinking and his hospitals and his sixteen-year murder spree. But even knowing the facts, I was still unable to fully connect the mild man across the glass with the serial killer and his monstrous crimes.

I tell him that some of the families of his victims are against the kidney donation, that they see it as special treatment for a serial killer, and nothing more. “I’m trying to get something? I’m in prison, I can’t control—there’s nothing to bargain for—no island off the coast of New Jersey that they send you to torture you, no Guantánamo Bay. All I can do is sit in a cell. And I know that New Jersey doesn’t make license plates anymore, so what would the families rather I did, just sit and watch TV?”

Cullen is indignant at a system that he said was willing to sacrifice an Ernie Peckham to punish a Charles Cullen. Saving a relative stranger’s life is undoubtedly heroic—would you give up a kidney?

Of course, heroic compassion is easier to talk about than mass murder. I can admire Cullen for the one and hate him for the other, but I have no idea how to connect the two—they seemed to be the actions of two very different men. And so I ask him: Is it any wonder people question your motives? You’re in prison for having taken dozens of lives, and yet now you’re fighting to save one. It seems … inconsistent.

Cullen is only a foot away, on the other side of the glass, but I cannot decipher his expression. Then he glances to the side of the glass, as if reading there, and slowly begins to speak.

“If you’re asking if I knew what I was doing was wrong,” he says, “I saw that I was stopping pain, removing pain. I saw it as shortening the duration of the pain, ending pain. Sometimes the pain was patients who were suffering and terminal; sometimes it was the pain of families being ripped apart; sometimes it was the lives of patients that would only be tied up in an endless series of procedures and complications and pain.

“But if you’re asking—well, I knew that it was illegal,” Cullen says. “And that it wasn’t my choice to make. But it’s how I thought about it. I felt compelled to do what I did. I didn’t see it as bad. I did know it was illegal.”

Cullen is looking at the table but not looking at it. I don’t know what he sees. “But, if you’re asking, when I was asked to donate a kidney, I felt that I did what I would normally do, in any circumstance. To be helpful. It was something that I could do. It was something that was needed. I was asked to do it, and it’s possible. And I felt compelled to, because I could do it and I was asked to.”

I don’t know what I expected from his answer. Ultimately, the only answer to the question of “why” is, simply, “because.” Cullen did what he felt he needed to, or wanted to, or could; at some point, they had become the same thing. In such a tyranny, bad and good don’t figure. It’s a simple answer, but it’s the only one that makes sense.

Cullen fixes me with a look, then takes his glance away, as if to study my response in private. “I know a lot of people find it surprising that someone like me would want to do this, donate. But for me, it’s totally consistent. For me, as a nurse, it’s what I would do, what I would have always done. It’s who I am. But if you need to wonder why I should, or why someone like me would, well, it really depends on how you think of people. And what you think people are capable of.”

As it happens, it was a Tuesday when the waiting ended. They came for Cullen in the night, guards with keys and handcuffs. He was going to the prison’s medical center at St. Francis hospital. If they knew why, they wouldn’t say. They gave him the paper gown again, drew his blood, cuffed him to the bed. The television in the corner was always on, local news, Oprah. A day passed, and he thought, Here we go again. He had only fourteen more days before his donor tests expired, but this wasn’t the donation. It was something else.

The guards came again in the morning. They were taking him downstairs; they didn’t say why. He was instructed to respond only to direct questions. He was told that Charles Cullen was not his name. His name was now Jonny Quest. The doctor called him Mr. Quest. It was a security measure, but also someone’s idea of a joke. Cullen thought it was funny. “It could have been worse,” he said later. “Saddam Hussein or something.”

They gave him something to relax him, Valium, he thinks; they wouldn’t say. It made him woozy. They gave him forms to sign. He held the pen, unsure of which name to use. “Use the one you’re supposed to,” the doctor said. He’d watched the cartoons as a kid, he remembered the handsome blond boy and his adventures, a helpful boy with skills, full of potential. He signed the paper “Jonny Quest.” It wasn’t legally binding, of course, so they gave him another form that he was to sign “Charles Cullen, a.k.a. Jonny Quest.” The nurse looked away when he did this. It was supposed to be a secret. Then they gave him another shot, and now he was feeling kinda gone.

An hour later, Jonny Quest’s kidney was tucked into a cooler and readied for its journey. It would have been crazy to risk traffic, so it likely flew via a Life Star helicopter, northeast from Trenton, keeping Manhattan on its left, banking up Long Island. That day the traffic far below was heavy with Hamptons weekenders, a line of lights leading past the massive Stony Brook medical complex, lit on the dark hillside like Bilbao under construction.

I parked in the C lot. On weekend nights, hospitals are usually busy only after the bars close and usually only in the emergency room. At 8 p.m., the main lobby was as quiet as a dead department store. A guard read yesterday’s newspaper again; the gift shop was just Mylar balloons in darkness. Surgery is on the fourth floor, with the burn unit and radiology. The kidney took the back elevator; I took the front.

In the surgical waiting room, the TV is always on, approximating normality for the families camped there, the children and their mothers holding each other, the men clutching Dunkin’ Donuts cups. This TV played the movie Freaky Friday, two people switching bodies and identities and, it being Hollywood and Disney at that, coming closer together as a result. But that was just a movie. For transplants, parts are parts. You take what you can get to survive.

And so, while Jamie Lee Curtis and Lindsay Lohan had their first mother-daughter argument about whose life was more difficult, Ernie Peckham lay face up on a table, anesthetized and encircled by masked strangers in disposable blue clothes. Some traced a curved incision through the fat of his abdomen, others parted the draped muscles of his belly wall with cool steel clamps. Johnny Quest’s kidney was about the size of a surgeon’s hand, a quivering bean shape mottled in yellowish fat that nested neatly into the half-shell of Peckham’s pelvis. A stump of renal artery, pruned only hours before from its owner’s aortal stalk, was patched into Ernie’s blood supply with 5-0 suture wire; vein was stitched to vein. And later, as Jamie Lee and Lindsay, back in their own bodies again, smiled knowingly at each other across a climactic concert scene, a surgical clamp was removed from an external iliac artery, and Jonny Quest’s kidney swelled pink with oxygenated blood, alive again—Ernie Peckham’s kidney now.

Underneath the xenon lamps, this medical miracle didn’t look like much more than cauterized gristle in a blue paper hole. It showed nothing of the millions of tiny tubules stacked inside its medulla, or the arterial branches, as infinite as crystals in frost, that would filter his blood as a brain filters choices, sorting bad from good as well as humanly possible.

Mr. Cullen was “just trying to help somebody who was going to die without a kidney,” Mr. Mask said. “I know there’s a certain amount of irony involved here.”

Cullen’s murderous career in the world’s most trusted profession spanned sixteen years and nine hospitals across New Jersey and Pennsylvania. In the aftermath, experts have stated that the reason Cullen was largely able to move from facility to facility undetected, was because of the lack of requirements to report on suspicious behaviour by medical workers, and inadequate legal protection for employers. New Jersey and Pennsylvania, like most states, required health care facilities to report suspicious deaths only in the most egregious cases, and penalties for failing to report incidents were minor. Many states did not give investigators the legal authority to discover where a worker had previously been employed. Employers feared to investigate incidents or give a bad employment reference for fear that such actions might trigger a lawsuit. According to detectives and Cullen himself, several hospitals suspected he was harming or killing patients, but failed to take appropriate legal actions. A number of hospitals had individual workers contact nearby hospitals in secret, to alert them that they should not hire Cullen.

Prompted by the Cullen case, Pennsylvania, New Jersey, and 35 other states adopted new laws which encourage employers to give honest appraisals of workers’ job performance and which give employers immunity when they provide a truthful employee appraisal. Many of the laws, passed in 2004 and 2005, strengthen disclosure requirements for health care facilities, bolster legal protections for health care facilities that report improper patient care and require licensed health care professionals to undergo criminal background checks and be fingerprinted at their own cost.